Philips Releases New, Shorter Cardiac MRI Protocol

In collaboration with the Spanish National Center for Cardiovascular Research, Philips has announced a new MRI technology that could change the playing field for cardiac imaging.

Currently cardiac MRI exams can last for approximately an hour with the patient lying still to avoid image degradation. On Wednesday, the Philips/CNIC team released details on a new ultra-fast cardiac MRI technique that creates a complete 3D heart image captured during a single breath-hold. According to company officials, it takes the same time as a CT scan, requires no X-ray exposure, and produces better images. 

Diagnostic Imaging spoke with the clinical leader on this work Borja Ibáñez, M.D., Ph.D., director of the CNIC clinical research department, and cardiologist at the University Hospital Fundación Jiménez Diaz, about the development of this technique and what it could mean for future patient care.

Diagnostic Imaging: Why has it become important to develop new techniques for cardiac MRI?

Ibáñez: Despite cardiac MR (CMR) being the gold standard technique for the evaluation of the heart, it is not universally used in daily practice. One of the main reasons for this is the long duration of scan time (usually around 45 minutes). Time of scan is a big issue for hospitals. In addition, the long duration of the scan can come with discomfort for some patients, especially the most vulnerable (elderly and pediatric).

The proposed technique allows for the performance of a basic CMR in three breath-holds, providing information of cardiac anatomy and function and to allow for the evaluation of scar tissue in cardiac muscle. The most novel part is the possibility to perform cine imaging of the heart in a single breath-hold without the need to set up planes. This revolutionary sequence, called ESSOS (Enhanced SENSE by Static Outer volume Subtraction) is a co-invention between CNIC and Philips. This technique can be used in most of the magnets already available in hospitals and, thus, it could be adopted very early by hospitals. This will massively increase the accessibility of patients to the gold standard technique for the evaluation of the heart and possibly improve patient management.

Credit: Philips Healthcare

Diagnostic Imaging: How is this new protocol different?

Ibáñez: The new protocol is based on 3D acquisitions for CINE (to assess morphology and function) and late gadolinium enhancement (to evaluate the presence of fibrotic tissue). Both acquisitions have isotropic resolutions allowing a subsequent reconstruction in any plane (cardiac views). Another major feature of this technique is the simplification of planning, which is basically reduced to the location of the chest cavity. This approach also reduces the time the patient spends in the scanner because it is not necessary to look for double oblique orientations that are normally very complex for less-trained operators.

Diagnostic Imaging: What benefits does it provide for both the patient and the provider?

Ibáñez: For patients, the proposed technique significantly increases comfort and reduces the chances for rejecting subsequent studies. It might also allow patients with moderate claustrophobia the option of being scanned. These advanced are especially noteworthy for vulnerable patients (i.e., elderly, patients with cancer, with chronic diseases, pediatric, etc).

For providers, this technique not only will reduce the time of scan, and, thus, increase the number of studies performed daily in the magnet, but also reduce the need to have very experienced operators for the acquisition of a CMR, something especially relevant for non-academic hospitals.

Diagnostic Imaging: What was significant about the results of your investigation?

Ibáñez: The proposed protocol has been successfully applied in a cohort of more than 100 patients with a variety of different cardiac conditions. The main result of this publication is that the functional parameters that are normally used for decision-making were strongly correlated with those obtained by classical 2D methodologies.

Diagnostic Imaging: What are the challenges to using the technique – what do radiologists need to be sure they know and understand about it?

Ibáñez: Patients should be aware that the single breath-hold is slightly longer that usual. Despite we are optimizing the sequence for further reduction, at this moment the breath-hold is 20 seconds. Operators should inform the patient that the first 10 seconds of the breath-hold are very important. Since reconstruction of done in real time in the scanner, if the patient breaths and the quality is not optimal, a second acquisition can be done

Diagnostic Imaging: Overall, when we think long-term, what is the potential impact of implementing this technique?

Ibáñez: It is clear that all MR scanning, including cardiac, is moving towards 3D methodologies. Approaches, like the one that we have published, with new techniques are very important in this sense. In addition, these approaches open the possibility to democratizing the technology, allowing more access to the population that can benefit from this imaging modality. In the past we saw a similar trend with the use of cardiac ultrasound, and now this revolution should come to the CMR field. This technique could be adopted as the standard for regular CMR exams in the close future.

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